title: Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors.
abstract: BACKGROUND
  Resection of diaphyseal malignant bone tumors is indicated for local control and impending pathological fracture or failure of prophylactic internal fixation. However, there are no large, long-term studies analyzing the results of intercalary reconstruction using segmental metallic spacers.
  
  
  METHODS
  We present 24 patients treated with wide resection for primary or metastatic bone tumors involving the diaphysis of the femur, tibia, or humerus and reconstruction using a modular intramedullary diaphyseal segmental defect fixation system. The mean length of bone resection was 10 cm. The postoperative complications and outcome were evaluated.
  
  
  RESULTS
  At a mean follow-up of 29 months, 17 patients were alive and 7 patients were dead of disease; no patient had local recurrence. Implant-related complications occurred in 8 patients, the most common being mechanical loosening and rotational instability. Loosening was most common in reconstructions of more than 10 cm length of bone resection. In all femoral reconstructions, mechanical failure occurred at the proximal stem. True limb length discrepancy of 2.0 cm was observed in one patient. Wound healing complications were not observed; range of motion and function of the adjacent joints was within normal limits.
  
  
  CONCLUSIONS
  The modularity, ease of application and preservation of the adjacent joints are major advantages of segmental modular prostheses; however, the complications' rate is high. Complications occur most often at the proximal stem in femoral reconstructions and reconstructions for more than 10 cm length of bone resection. In these cases, the use of these implants should be reconsidered or not recommended.
authors.affiliation: Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy. pietro.ruggieri@ior.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bianchi
authors.forename: Vassileios I
authors.initials: VI
authors.lastname: Sakellariou
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D018483:Diaphyses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome